City, State, Zip: ____________________

Phone number (optional): (_____) _____-_______

E-mail address (preferred): ___________________________________

Ship-to address (if different from above)

____________________

____________________

____________________

Is this a gift? (Circle one): Yes No

If yes, and you want a message, please write one below (legibly):

__________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________

Your order

Item description	Color/scent	Quantity	Price (each)	Total price
1	.	.	$	$
2	.	.	$	$
3	.	.	$	$
4	.	.	$	$
5	.	.	$	$
6	.	.	$	$
7	.	.	$	$
8	.	.	$	$
9	.	.	$	$
10	.	.	$	$
			Shipping/handling	$
			Total	$

To calculate shipping on your order:

First soap item: $2.00
Each additional soap item: $1.00

First candle item: $3.00
Each additional candle item: $1.50

If mixing a soap and candle order, consider your first item to be a candle (with regards to shipping) and calculate additional items from there. (ie, if you have 2 candles and 2 soap, it would be $3.00 initially, then $1.50 for the second candle, and $1.00 for each soap.)

NOTICE: The address above is for shipping purposes only, and will not be given out, sold, or otherwise advertised to ANYONE, as per the Privacy Act Statement of 1974. Please sign below acknowledging this statement. Be advised, your address will be kept on file, but should be included with every order, just in case.

Signed: ________________________________ Date: _________________